Term birth after midtrimester hysterotomy and selective delivery of an acardiac twin.

OBJECTIVE

Our aim was to determine whether hysterotomy and selective removal of an acardiac twin could improve the outcome of the "pump" twin.

STUDY DESIGN

A literature and case review of the outcome of the acardiac twin malformation was performed. When an acardiac malformation was diagnosed at 19 weeks' gestation the patient was monitored with weekly ultrasonographic examinations. At 23 weeks' gestation, no blood flow could be demonstrated to the acardiac twin and it was thought that the continued presence of the acardiac twin posed a risk to the "pump" twin. A midtrimester hysterotomy was performed and the acardiac twin was delivered.

RESULTS

After the midtrimester hysterotomy, the pregnancy progressed to term and a healthy female infant was delivered by elective cesarean section at 37 weeks' gestation.

CONCLUSION

Midtrimester hysterotomy may be a useful intervention in cases of twinning when one fetus is a threat to the health of the other.